Risk factors of cardiovascular disease in patients with diabetes

Abstract:

The risk of developing cardiovascular disease (CVD) in both forms of diabetes - type 1 diabetes (T1DM) and type 2 diabetes (T2DM) has increased by 2-4 times compared to people without diabetes who have already suffered a myocardial infarction. Both sexes are under the same risk, and it is important to note that premenopausal women with diabetes lose the protective role of hormones against the development of CVD. Nearly 75% of patients with diabetes die from CVD, and myocardial infarction is a cause of death in 30% of patients. Diabetes, especially type 2, is characterized by a high risk of developing atheroma in the arteries which supply the heart, brain and limbs. Atheroma develops earlier and faster, causing widespread lesions in the arterial bloodstream, along with affecting the small arteries. Intimal-medial thickness is an early sign of damage to the artery. Hyaline degeneration and thickening of the smooth muscle of the arterial media are the cause of hypertension and calcification (medial sclerosis). Risk factors for atherosclerosis include hyperglycemia, hypertension, dyslipidemia, and central adiposity. These factors, when co-occuring with resistance to the effects of insulin (prediabetes type 2 or developed T2DM) create “metabolic syndrome” (MS). MS is the most powerful generator for creating accelerated atherosclerosis or CVD. Blood coagulation and fibrinolysis disorders are also associated with the existence of MS, and certainly influence the development of atherosclerosis. Careful regulation of blood glucose, as of those in healthy individuals, shows no reduction of CVD, unless patients take metformin which significantly reduces the rate of fatal myocardial infarction in patients with T2DM. The effect that metformin has is probably due to its non-glycemic effects (thrombosis reduction, lowering blood pressure and reducing obesity). 

Key words:
atherosclerosis; hyperglycemia; hyperinsulinemia; macrovascular complications; oxidative stress; risk factors for cardiovascular diseases; type 1 diabetes; type 2 diabetes